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Cited by 35Sepsis Diagnosis and TreatmentHemodynamic Monitoring and TherapyAbdominal Surgery and Complications

Active fluid de-resuscitation in critically ill patients with septic shock: A systematic review and meta-analysis

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Messmer, Anna S., Dill, Tatjana, Müller, Martin, Pfortmueller, Carmen A.·2023·European Journal of Internal Medicine
DOI 10.1016/j.ejim.2023.01.009
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Abstract

Purpose To evaluate the impact of active fluid de-resuscitation on mortality in critically ill patients with septic shock. Methods A systematic search was performed on PubMed, EmBase, and the Cochrane Library databases. Trials investigating active fluid de-resuscitation and reporting data on mortality in patients with septic shock were eligible. The primary objective was the impact of active de-resuscitation in patients with septic shock on short-term mortality. Secondary outcomes were whether de-resuscitation lead to a fluid separation, and the impact of de-resuscitation on patient-centred outcomes. Results Thirteen trials (8,030 patients) were included in the systematic review, whereof 5 randomised-controlled trials (RCTs) were included in the meta-analysis. None of the RCTs showed a reduction in mortality with active de-resuscitation measures (relative risk (RR) 1.12 [95%-CI 0.84 - 1.48]). Fluid separation was achieved by two RCTs. Evidence from non-randomised trials suggests a mortality benefit with de-resuscitation strategies and indicates a trend towards a more negative fluid balance. Patient-centred outcomes were not influenced in the RCTs, and only one non-randomised trial revealed an impact on the duration of mechanical ventilation and renal replacement requirement (RRT). Conclusion We found no evidence for superiority of active fluid de-resuscitation compared to usual care regarding mortality, fluid balance or patient-centred outcomes in patients with septic shock.…

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  • Systematic reviews and meta-analyses found no evidence that fluid restriction or fluid de-resuscitation is superior to higher fluid volumes for mortality in septic shock.

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    From Artificial Intelligence to Facilitate SEP-1 Measure Compliance and Fluid Management in Sepsis (2026) · cites this paper as [24]

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Cited by

Sorted by citations

Authors
Messmer, A. S., Dill, T., Müller, M., & Pfortmueller, C. A.
Affiliations
University of Bern (CH)
ORCID
Venue
European Journal of Internal Medicine
Publisher
Elsevier BV
Published
2023-03
Volume
109
Pages
89-96
ISSN
0953-6205 (ISSN-L)
DOI
10.1016/j.ejim.2023.01.009
OpenAlex
W4315498546
Cited by
35
References
4
Citations by year
2026: 10 · 2025: 12 · 2024: 9 · 2023: 4
FWCI
1.37
Type
journal article
Language
en
Open access
Licence
Locations
  • European Journal of Internal Medicine (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Bern Open Repository and Information System (University of Bern) (submittedVersion, cc-by)
  • Open Access CRIS of the University of Bern
Topics
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
  • Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
  • Health Sciences › Medicine › Surgery › Abdominal Surgery and Complications
Keywords
septic shock, critically ill patients, mortality, fluid balance, fluid separation, patient-centered outcomes, mechanical ventilation duration, renal replacement therapy, fluid overload
MeSH terms
Fluid Therapy, Humans, Respiration, Artificial, Resuscitation, Shock, Septic, Critical Illness

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